Friday, September 04, 2009

The NHS may need to cut its workforce by about 10 per cent — the equivalent of 137,000 staff — to help to meet planned savings of £20 billion, according to a leaked Department of Health report. A study commissioned from the consultancy firm McKinsey and Company recommends cutting clinical staff posts as well as administrators to meet efficiency savings by 2014, suggesting a knock-on effect to patient care.

The report, seen by the Health Service Journal (HSJ), recommends a range of possible actions, such as a recruitment freeze starting in the next two years, a reduction in medical school places from October and an early retirement programme to encourage older GPs and community nurses to make way for “new blood/talent”.

The report was presented to the Department of Health in March, the HSJ says today. It carries the department’s logo and has been distributed among senior NHS managers. The study said £2.4 billion could be saved if hospitals with the lowest levels of staff productivity improved to become nearer the average levels. It added that almost 40 per cent of patients in a typical hospital did not need to be there.

Productivity is notoriously difficult to measure in an organisation as large as the NHS, which employs 1.5 million staff, but the biggest causes for patients staying unnecessarily long in hospital were delays in receiving tests or therapies, or a lack of suitable carers or facilities that meant patients could not go home.

The report also said that if four million of the 29 million outpatient appointments each year could be cut, it would save £600 million. A further £700 million could be saved if procedures with limited clinical benefits — such as tonsillectomies, varicose vein removal and some hysterectomies — were no longer performed.

The analysis also suggests that up to £8.3 billion of hospital estates could be “freed up” or sold to generate income.

Andrew Lansley, the Shadow Health Secretary, said: “Yet again Labour ministers are failing to be straight with the British people. “Andy Burnham [the Health Secretary] promised to protect the NHS, but now we find out that his department has been drawing up secret plans for swingeing cuts. “Clearly, we need to get better value for money from the NHS, so we applaud any drive for greater efficiency, but it is extraordinary that Labour plan to take an axe to the hospital budget rather than to the bloated health bureaucracy. “Only a fifth of job cuts would be within the bureaucracy, meaning the vast majority to go would be frontline NHS staff.

“After years of declining productivity, this report shows that Labour still doesn’t get it. “Instead of relying on plans drawn up by management consultants for top-down cuts, they should be looking to create incentives through the way hospitals are paid, which would drive up standards and drive down costs.”

The NHS has apologised after writing to a man to address concerns over his treatment - three-and-half years after he died. Tom Milner's daughter emailed the National Patient Safety Agency (NPSA) after her 76-year-old father died at Sheffield's Northern General Hospital. Janet Brooks said when she received a response, it was entitled "Dear Tom". The agency said it had reviewed its systems to ensure the error did not happen again.

Mr Milner, who had terminal leukaemia, was not given his prescribed pain-relieving morphine in the last two days of his life, his family say. They claim he was left in agony and lay in his own urine and blood at the NHS palliative care ward at the hospital. The health trust responsible for his care said staff had "acted appropriately".

Mrs Brooks, 54, of Emsworth, Hampshire, said she had outlined her concerns about her father's treatment in an email to the NPSA. "They responded with 'Dear Tom'. "It's an example of the careless and shambolic attitude by the NHS towards my father and our family."

A spokesman for the National Patient Safety Agency said: "The NPSA is aware that an error was made when responding to an email enquiry from the relative of a deceased patient. "As soon as this was identified, we contacted the person involved and apologised for any distress caused. "The NPSA has also since reviewed its systems to look at how it can ensure this does not happen again."

Dr David Throssell, deputy medical director at Sheffield Teaching Hospitals NHS Foundation Trust, said: "The Healthcare Commission found that staff acted appropriately. "Mr Milner indicated he was not in pain and therefore the doctor agreed with the nurse that further medication was not required." [Typical British coverup. How likely is it that the man suddenly became pain-free as his illness worsened?]

Mark Colvin, a journalist with the ABC, Australia's state-owned broadcaster, has a disdainful essay about the ObamaCare debate. He dismisses skeptics as a bunch of liars and tells this story, which is supposed to illustrate the glories of socialized medicine in the form of Britain's National Health Service:

I became ill in Britain in 1994, not long after an assignment for the ABC in Rwanda and Zaire.

The disease I had contracted proved exceptionally difficult to diagnose--it's rare, and presents a varying range of symptoms. After several visits, my National Health Service doctor had the sense and humility to confess himself beaten, and sent me to London's Hospital for Tropical Diseases. There, also on the NHS, I was tested exhaustively for every known tropical disease.

If I'd been in America, I'd have already have spent thousands--in Britain I'd spent nothing.

But this was also where one of the failings of the NHS kicked in: waiting-lists. The Tropical Disease doctors discharged me with instructions to see another specialist, but when I rang him I discovered he couldn't see me for six weeks. My condition was deteriorating fast, so when the ABC's Dr Norman Swan got on the phone from Sydney to offer help, I jumped at it. He got to work and within a day had made an appointment for me with the doctor who would go on to save my life.

Insured by the ABC, I ended up spending almost six months in hospital. I was in a private ward, but treated in a National Health Hospital. The food was better in the private ward, and I had privacy, but I am certain that the treatment was the same. My doctors were sparing time for me out of their public rounds.

Norman Swan is a physician turned medical journalist, an Australian Bob Arnot or Sanjay Gupta. So the NHS is great, provided that (1) you have insurance provided by a foreign employer, and (2) you're friends with a media-star doctor, who can help you jump the line.

Long delay forces heart victim to take a taxi. A taxi arrived in 5 minutes: The contrast between a government service and a private one. And the government service was the urgent one!

A PETRIE man with a serious heart condition took a taxi to the hospital after he gave up waiting more than an hour for a Queensland ambulance. John Chatfield said his blood pressure soared, his heart was racing and he was shaking with fever when his wife Gaye rang 000 at about midnight on August 9. She called twice more, without being given a projected response time. After waiting an hour and a quarter, they called a taxi. It arrived in five minutes.

"If you have a heart condition, you probably shouldn't drive to a hospital as anything could happen," said Mr Chatfield, who had seven-hour heart surgery three years ago and minor surgery earlier this year. "Speed is important. They need to get their act together."

Wrapped in a blanket, Mr Chatfield rode 45 minutes in the taxi to a private Brisbane hospital, where he was admitted straight away. "I was ill. It wasn't a great ride," he said. He was in hospital for three days battling a bad virus.

The Queensland Ambulance Service said it categorised Mr Chatfield "Code 2 B" meaning a response time of up to an hour. Gaye Chatfield said that if she had been told about the response time, she would have driven him or called the taxi sooner. "Even after the last phone call they couldn't tell me how long it could be. I had in my mind that I could have been another hour," she said. "It wasn't very well handled."

She told dispatchers about her husband's cardiac history, but not about his surgery because she wasn't asked. Instead she was told to turn on lights and put pets away, which led her to believe the ambulance was coming soon.

QAS said more important calls were being handled, and the dispatch category was "appropriate." It said it "regretted" the delay and said it would apologise. [big deal!]

Mr Chatfield does not blame the paramedics or line staff at QAS, but thinks QAS management needs to lift its game. He didn't see his case as a non-emergency, considering his heart problems. "I was getting worried I can tell you," he said.

QAS said dispatchers didn't give callers response times. "QAS works in a dynamic environment and it would not be realistic to provide time frames," a spokeswoman said.

Leftist Australian government forces IVF couples to have police checks

Infertility is a medical problem. Why are people being harassed because of their medical condition? Will people having treatment for (say) high blood-pressure be singled out next? It would make as much sense. There is Leftist misanthropy behind this

WOULD-BE parents are outraged at new laws forcing them to prove they are not pedophiles or child abusers before they undergo fertility treatment. Victorian IVF clinics have started asking patients to submit to police checks ensuring they are fit to be parents. The new law will affect about 5000 couples each year.

Briony and Lew Sanelle, who completed police checks three weeks ago so they could start trying to have their second child through IVF, said they were insulted by the discrimination. "My friends trying to have babies don't have to have a police check and go and talk to their doctor before they are given the go-ahead to have a baby, so why should I?" Ms Sanelle said. "People who have a shady past who they are trying to direct this at do not have to go through this to conceive naturally . . . this is discrimination."

Tam and Brenton Ward were asked by Melbourne IVF to undertake checks this week. They cannot understand why couples having fertility treatment were singled out. Having already experienced the wonders of IVF with a daughter born 17 months ago, Mr Ward said the emotional and financial hardship meant IVF parents would be least likely to harm or neglect children. "If it applied to the whole community I would not mind, but why single out people like us in particular, especially when we have been through such a rigorous process already - through numerous counsellors, doctors and everyone else."

The requirements were included in the Reproductive Treatment Bill passed by State Parliament last December, which paved the way for single women and lesbians to access IVF. Although the regulations were proclaimed on June 1 they have not yet been enacted because the Government does not have the resources to deal with hundreds of child protection record checks it demands. But clinics are asking patients to volunteer for checks to avoid hold-ups when the laws are adopted, which industry experts expect to happen between November and January 1.

IFV pioneer Prof Gab Kovacs, from Monash IVF, said his patients were stunned when told they would have to undergo police checks. "It is a stupid regulation, a stupid law and it is not evidence-based," Prof Kovacs said. Melbourne IVF chairman Dr Lyndon Hale said the checks were discriminatory and unfair.

A report from the Victorian Law Reform Commission recommends people should be barred from IVF if they have convictions for serious sexual or violent offences, have had children taken from their care, or are assessed as a potential risk to children. [On what basis did they recommend that? How many cases of abused IVF children have there been? None, I suspect. They might as logically bar ALL people from hospitals until they have police checks]

This is a total absurdity motivated by a Leftist hatred of drug companies. If a drug has been found safe and effective and approved by the FDA, why cannot it be used for conditions related to the original condition for which it was approved? Is there any proof of harm done? It is a bureaucratic offence only and should not be attacked without evidence of harm done

PFIZER agreed to plead guilty to a US criminal charge overnight and has been ordered to pay a record $US2.3 billion ($2.7 billion) to settle allegations it improperly marketed 13 medicines. The world's biggest drugmaker was slapped with the huge fines after being deemed a repeat offender in pitching drugs to patients and doctors for unapproved uses.

Pfizer pleaded guilty in 2004 to an earlier criminal charge of improper sales tactics and its practices have been under US supervision since then. "If another one of these charges crops up, it would raise questions whether Jeff Kindler is keeping everyone at Pfizer on a tight enough leash," said Miller Tabak analyst Les Funtleyder, referring to Pfizer's chief executive officer. Mr Kindler had been Pfizer's general counsel from 2002 until taking the helm in 2006.

The company in January said it took a $US2.3 billion charge late last year to resolve allegations involving Bextra and other drugs, but did not provide details at the time. "The size and seriousness of this resolution, including the huge criminal fine of $US1.3 billion, reflect the seriousness and scope of Pfizer's crimes," said Mike Loucks, acting US attorney for the District of Massachusetts.

The settlement includes a $US1.3 billion criminal fine related to methods of selling Bextra, which was withdrawn from the market in 2005 on safety concerns. Pfizer acquired Bextra in its 2003 purchase of Pharmacia. Pfizer's marketing team promoted Bextra for acute pain, surgical pain and other unapproved uses, while its salesforce promoted the drug directly to doctors for those unapproved uses and dosages, according to the Justice Department. The company and Pharmacia also used advisory boards, consultant meetings and provided travel to lavish resorts to improperly promote Bextra to doctors and made misleading claims about the drug's safety and efficacy, the Government said.

The settlement also includes $US1 billion in civil payments related to so-called "off-label" sales of drugs - meaning for uses not authorised by the US Food and Drug Administration - and payments to healthcare professionals. Pfizer denied all of the civil allegations, except for acknowledging improper promotions of the antibiotic Zyvox. "We regret certain actions taken in the past, but are proud of the action we've taken to strengthen our internal controls," said Amy Schulman, Pfizer's general counsel.

Justice Department officials said cracking down on fraud in the healthcare industry was a key priority and comes as President Barack Obama is trying to push through reforms of the $US2.5 trillion healthcare system to clip soaring costs.

The settlement and guilty plea are not expected to significantly hurt Pfizer's ability to sell drugs, Morningstar analyst Damien Conover said. "However, it could send the wrong message at a time when you're making some pretty critical negotiations with the US Government on healthcare reform."

The settlement is the largest to date for improper marketing of prescription drugs, topping the $US1.42 billion Eli Lilly and Co agreed to pay earlier this year for off-label sales of its Zyprexa schizophrenia drug. Pfizer said it will pay $US503 million to resolve practices involving Bextra, $US301 million related to its schizophrenia drug Geodon, $US98 million for Zyvox and about $US50 million for its blockbuster Lyrica used to treat nerve pain and seizures.

On top of the $US2.3 billion fine, Pfizer said it would take new charges of up to $US33 million to resolve state civil consumer fraud allegations related to promotions of Geodon. Pfizer did not specify whether it had disciplined any executives in connection with the latest infractions.

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here